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Nurul Qalby C111 13 064

A. Anisa Nasir C111 13 082


Sitti Magfirah Adnan C111 13 090

Division of Rheumatology
Departement Of Internal Medicine
Medical Faculty of Hasanuddin University | Makassar 2017
PATIENT IDENTITY

Name : Mr. A
Date of Birth : 09/08/1971
Age : 46 years old
Address : Makassar
Religion : Moslem
Race : Javanese
Job : Radiographer
Medical Record : 249276
HISTORY TAKING

Chief complain: Pain at both knee joints


The pain felt since 1 month ago especially when moving or
exercising and the pain reduced when resting.
The pain is only felt locally and not spreading. The patient
felt morning stiffness about 5 minutes. There is also swelling
and warmth around the joint.
Patient said that the body weight is increased since 3
months ago.
No history of trauma, no complain in other joint.
There is no History of diabetes mellitus and hypertension.
History of hyperurisemia is unknown.

No history of smoking and alcohol consumption.

History of the same complain in family is unknown.


STATUS PRESENT

General Description Vital Signs


General condition : Mild Awareness : Compos mentis
illness Blood pressure : 127/93 mmHg
Nutrition : Obese Heart rate : 100x/min,
Height : 165 cm regular
Weight : 86 kg Respiratory rate : 20 x/min,
BMI : 31,6 Temperature : 36.8C (axilla)
kg/m2 (N= 18,5 22,9) VAS : 3/10
PHYSICAL EXAMINATION
Head and Neck:
Pale Conjunctiva (-), Icteric (-), Cyanosis (-)

No lymph enlargement and stiff at neck

Thorax :

I : Symmetrical left and right,


P : No tumor mass , No tenderness
P : Sonor in both lung fields
A : The sound of breathing: Vesicular
Additional sound: No rhonki. no wheezing.
PHYSICAL EXAMINATION
Heart :
I : Ictus cordis looked at ICS V linea medioclavicularis sinistra.
P : Ictus cordis palpable at ICS V linea medioclavicularis sinistra.
P : Right heart border in ICS IV linea parasternalis dextra;
Left heart border in ICS V linea medioclavicularis sinistra
A : Heart sound I / II pure, regular. No Gallop

Abdomen :
I : Flat, follow the motion of breath,
A : Peristaltic (+) normal impression.
P : hepar and lien not palpable
P : Tympani (+)
RHEUMATOLOGICAL STATUS
Gait : Normal

Arms : Normal

Legs :
Genu dextra : Tumor (-), calor (-), dolor (+), tenderness (+), rubor (-), Limited
ROM (+), crepitus (+), bony enlargement (+), bulge sign (+)
Genu sinistra : Tumor (-), calor (-), dolor (+), tenderness (+), rubor (-), Limited
ROM (+), crepitus (+), bony enlargement (+)

Spine : Normal
Radiology Examination 11/07/2017

Result :
Osteophytes in eminentia intercondylaris genu dextra et sinistra.
Osteartritis Genu Bilateral
PATIENT PROFILE
Problem List
Problem Plan Diagnostic Plan Therapy
1. Osteoarthritis Genu Bilateral - Sinovial fluid Education to reduce body
analyze weight, exercise, reduce
Based on American College of - ESR high activities.
Rheumatology criteria of knee osteoarthritis:
- Less than 30 minutes of morning stiffness Pharmacology
- Crepitus on active motion
Paracetamol 1000 mg/8
- Bony tenderness hours/oral (if pain)
- Bony enlargemet
Arthrosentesis and steroid IA
- No palpable warmth of synovium injection
- Radiologi : Osteofit
Discussion
DEFINITION

Osteoarthritis (OA) is the most common type of arthritis. OA is


joint failure, a disease in which all structures of the joint have
undergone pathologic change, often in concert.

The pathologic of disease is hyaline articular cartilage loss,


present in a focal and, initially, nonuniform manner. This is
accompanied by increasing thickness and sclerosis of the
subchondral bony plate, by outgrowth of osteophytes at the
joint margin, by stretching of the articular capsule, by mild
synovitis in many affected joints, and by weakness of muscles
bridging the joint.
ETIOLOGY
1. Primary OA : Idiopathic
2. Secondary OA :
Inflammation
Endocrine abnormality
Genetic
Immobilization
Age Obesity

Risk Factor
Sex Trauma

Race or etnicity

Genetic
Joints affected by
osteoarthritis
Overview of the
process
Articular cartilage gets
disrupted

Damage progresses
deeper to subchondral
bone
Fragments of cartilage
released into joint
Matrix degenerates

Eventually there is

complete loss of cartilage


Bone is exposed
CLINICAL MANIFESTATION
1. Joint pain
This is the main complaint of the patient to go to the hospital
2. Decreased Range of Motion
Caused by genu effusion
3. Morning stiffness less than 30 minutes
4. Crepitus
5. Bony enlargement or deformity, enlargement of distal femur and
tibia, PIP joint (Nodus Bochart) and DIP (Nodus Herbenden)
6. Abnormal gait
7. Inflammation sign, can caused by sinovitis
CLINICAL MANIFESTATION

Heberdens nodes

Bouchards nodes
Radiograhic Findings
DIAGNOSIS
ACR Clinical Classification Criteria for Osteoarthritis of the
knee:

1. Using history
and physical
examination
DIAGNOSIS

2. Using history,
physical
examination and
radiographic
findings :
DIAGNOSIS

3. Using history,
physical examination
and laboratory
findings
DIFFERENTIAL DIAGNOSIS
TREATMENT
Non pharmacology :
- Education
- Self management programs
- Reduce body weight (if BMI >25)
- Low impact aerobic fitness exercise
- Physical therapy
- Ocupational therapy
TREATMENT
TREATMENT
TREATMENT
Surgical therapy:
Malalignment, valgus-varus knee deformity
Arthroscopic debridement and joint lavage
Osteotomy
Total arthroplasty knee joint
Thank you